Unhappy with my implants/lift. Are they laterally displaced, malpositioned? I want a revision. How do I fix my problem? (Photo)

I had a breast augmentation with a lollipop lift. I wanted my breasts to be "up and in." I wasn't interested in making them larger, my goal: (perky). My doctor suggested a lollipop lift with high profile implant (mentor). I decided on 250 cc implants. She had suggested bigger at the time, maybe she was right? I saw her about a revision. She suggested a larger moderate implant with a Capsulorrhaphy and Strattice. I wish she would have just suggested the moderate profile to begin with.

Doctor Answers 9

The sternum and plane of the chest wall determine whether breasts are oriented forward, or more outward, especially when supine


Your starting point predicts the result that you have, which is a very good one.  A few things need to be understood regarding augmentation and augmentation with lifts. First of all, the steep slope of your chestwall laterally (especially seen when lying on your back--i.e. supine) causes your breasts to diverge outward, with your breasts and nipples pointing in a direction perpendicular to the plane of the chestwall when standing or supine.  This is because of the angle at which your ribs approach the breastbone, and is borne out by the high medial to low lateral divergent (directed away from each other) lower pole folds that you show pre-op and post-op.  Further, with a steep lateral chestwall slope and prominent sternum the cleavage tends to immediately separate outward, rather than running more close and parallel as is seen in a patient with a less prominent sternum, flatter chestwall plane, and thus less divergent folds.  In my experience about 40% of patients have a more prominent breastbone and steeper outward chest wall slope, as you have, and that puts more lateral strain on the implants when supine and tends to lead to gradual outward implant displacement, mainly seen when supine, due to inevitable tendency to lateral pocket capsule stretch if unsupported.  Larger implants will indeed make your breasts larger but will not bring them closer together because they will not change the configuration of your chestwall which is the reason why your breasts do not point more forward and are not closer together like you want them to be.  Further, because lifts cannot cure the tendency to sag, and there is no way to change this tendency, either the upper pole fullness that one initially gains with a lift alone is eventually lost, but will be much better preserved with placement of implants, as you have done. Your surgeon has done a very nice job, and you have an excellent result from your starting point, but it is the starting point chestwall geometry and the genetic tissue support integrity that will determine the final potential outcome.  Some maneuvers that have been tried to preserve greater upper pole support after mastopexy with implants include use of internal slings of acellular dermis (Flex-HD, Strattice, Alloderm, etc).  Some surgeons also use acellular dermal grafts to support lateral capsulorrhaphy repairs to repair lateral implant displacement, but I do not usually find that necessary to achieve stable lateral repairs.  This is a lot of information to digest, but enter the attempt to change this outcome with open eyes, as you cannot change the physical characteristics that dictate the outcome geometry.  I hope that this helps.  Impact of the chestwall slope and other factors that relate to attainable cleavage are discussed on the page that follows, and my gallery pages show many examples of lateral implant displacement repairs.

Richmond Plastic Surgeon
4.3 out of 5 stars 35 reviews

Strattice not the answer

Thank you for your question and photographs.  Your implant pocket is, obviously, too lateral.  This could be due to a pronounced curvature of you rib cage, the pocket being created too laterally, or both.  As the lift was the most important procedure that you were interested in, I likely would have opted for a full lift rather than the vertical lift.  I agree that a moderate plus profile implant would be better for you.  Repositioning the implant pocket more medially with a lateral capsulorrhaphy should resolve your issues.  I do not feel that adding Strattice or any other ADM is necessary in these cases and it significantly increases the cost.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 38 reviews

Unhappy with my implants/lift. Are they laterally displaced, malpositioned? I want a revision. How do I fix my problem?

The result though acceptable could be improved by re lift + change implants. But you are laterally anatomically positioned breasts so the possibility of more centralized breasts is not realistic... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Peerky breasts

Consider a revision with a smaller implant with lateral capsulorraphy and mastopexy elevating the nipple areolar complex to the level of the inframammary fold. Certainly a more detailed discussion concerning your wishes is appropriate

Michael Eisemann M.D.
Plastic Surgeon
Houston, Texas

Michael Eisemann, MD
Houston Plastic Surgeon
3.5 out of 5 stars 19 reviews

Unhappy with my implants/lift

Thank you for your question and photo.  No online reviewer can diagnose or recommend treatment without more information and an exam.  It appears you have persistant ptosis.  It may be that your tissues can not support your breasts or the additional implants.  It is important for a patient to have a good rapport with their plastic surgeon and to discuss any concerns.  Sometimes as much as we don't want to ahve sagging breasts we can not reiably correct this.  I would recommend a a face to face consult with a Board Certified Plastic Surgeon who has experience in breast surgery. During your visit your surgeon should be evaluating your health to determine if you are a good surgical candidate and examining your tissues to get a sense of what type of procedure your tissues will allow. Only with a hands on exam can this be determined. During the consult you and the surgeon should be understanding of the goals and realistic outcomes of your choices. Be sure to see plenty of before and after photos to get an idea of the range of patient experience of your surgeon. Once an exam and opinion is rendered then you can decide if surgery is right for you. Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
4.8 out of 5 stars 24 reviews

Unhappy lift and implant result

From the photos you supplied it appears that the breast implant have migrated outwards leaving a wider than desired cleavage. I would agree with your PS to increase the base width of the implant, use a textured implant and do a lateral capsulorraphy with Strattice as an insurance that they dont migrate outward again. Good Luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Unhappy with my implants/lift. Are they laterally displaced, malpositioned? I want a revision. How do I fix my problem?

Hello dear, thanks for your question and provided information as well..
The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions, but  also help bras and swimsuits fit more comfortably and attractively. By removing excess, stretched out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position, a cosmetic surgeon can create a more youthful breast contour. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast, Actually the perkiness on a person or another, depends on patients skin and breast tissue, hugs!

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 417 reviews

Breasts sagging after initial lift is quite common

Breasts sag based on their weight and skin elasticity.  When weight is added to a lifted breast this process gets started.  Larger the implant more is sagging.  Profile of implants actually does not matter. 

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

Breast lift

Depending upon what you want, the lift can be revised  and perhaps adjust the implants.  Best to be evaluated in person.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.